Was COVID-19 a heyday for education? Lessons learned from a COVID-19 "pop-up" simulation developed overnight.

Introduction: To adjust for the COVID-19 pandemic's rapidly changing guidelines and clinical needs, educators turned to simulation to create realistic yet safe environments for drilling and innovating various care strategies. Individually, institutions faced creating a pathway for deploying new behaviors and techniques widely across their populace. Methods: In response to this need, we rapidly developed an interprofessional teaching curriculum for safe intubation techniques and donning/doffing of personal protection equipment to anesthesiology clinicians and technicians. Participants were taught using Roussin's Zone 1 simulation techniques including coaching from interprofessional facilitators. Survey data were collected from participants. Results: Participants' confidence levels increased, with coaching and the use of simulation cited as the most useful elements of the training. Conclusions: We believe COVID-19 catalyzed many educational initiatives, and though teams drew their own roadmaps to create programs, sharing the learning from these endeavors may inform future similar situations. Lessons of stakeholder buy-in, use of multidisciplinary teams, and building a psychologically safe space can promote rapid uptake of new techniques and technologies.

Exploring cultural sensitivity during distance simulations in pediatric emergency medicine.

Background: Cultural sensitivity (CS) training is vital to pediatric emergency medicine (PEM) curricula. This study aimed to explore CS in Yale PEM fellows and emergency medicine (EM) residents at Indus Hospital and Health Network (IHHN) in Pakistan through distance simulation activities. Methods: This mixed-methods analysis of an educational intervention was conducted at Yale University in collaboration with IHHN. We approached seven U.S. PEM fellows and 22 Pakistani EM residents. We performed a baseline CS assessment using the Clinical Cultural Competency Questionnaire (CCCQ). Afterward, the U.S. PEM fellows facilitated the Pakistani EM residents through six distance simulation sessions. Qualitative data were collected through online focus groups. The CCCQ was analyzed using descriptive statistics, and content analysis was used to analyze the data from the focus groups. Results: Seven U.S. PEM fellows and 18 of 22 Pakistani EM residents responded to the CCCQ at the beginning of the module. The mean (±SD) CCCQ domain scores for the U.S. PEM fellows versus the Pakistani EM residents were 2.56 (±0.37) versus 2.87 (±0.72) for knowledge, 3.02 (±0.41) versus 3.33 (±0.71) for skill, 2.86 (±0.32) versus 3.17 (±0.73) for encounter/situation, and 3.80 (±0.30) versus 3.47 (±0.47) for attitude (each out of 5 points). Our qualitative data analysis showed that intercultural interactions were valuable. There is a common language of medicine among the U.S. PEM fellows and Pakistani EM residents. The data also highlighted a power distance between the facilitators and learners, as the United States was seen as the standard of "how to practice PEM." The challenges identified were time differences, cultural practices such as prayer times, the internet, and technology. The use of local language during debriefing was perceived to enhance engagement. Conclusion: The distance simulation involving U.S. PEM fellows and Pakistani EM residents was an effective approach in assessing various aspects of intercultural education, such as language barriers, technical challenges, and religious considerations.

Design and Validation of a Simulation Scenario and Assessment Tool: A Pilot Project.

In 2016, the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) launched a Continued Professional Certification (CPC) Program to promote lifelong learning and to facilitate ongoing professional competency checks for practicing certified registered nurse anesthesiologists (CRNA). The use of simulation-based assessment is currently being studied by the NBCRNA for potential use in the CPC Program. The aim of the pilot project was to create and validate simulation scenarios and assessment tools for potential incorporation into the CPC Program. Using the modified Delphi method, an expert panel of eight CRNAs evaluated the validity of four simulation scenarios and the content validity and reliability of four scenario-specific assessment tools. Each of the eight individual surveys assessing simulation scenario validity and assessment tool validity reached ≥ 75% agreement among the expert panelists. Overall content validity index values for the four assessment tools ranged from 0.960 to 0.993. There was a direct relationship between panelists' scores and level of performance on all returned assessment tools. The expert panel validated four simulation scenarios and four accompanying assessment tools. All scenarios and assessment tools were determined to have high content validity and reliability. Using these scenarios and assessment tools would provide unique advantages over standardized assessment methods.

Pilot Study Using Cognitive Rehearsal, Simulation, and Biomarker Data to Address Workplace Incivility.

BACKGROUND: Workplace incivility poses a threat to patient safety. This intervention pilot study used simulation and biomarker data with newly graduated nurses to explore the impact of incivility on patient care and tested whether cognitive rehearsal could mitigate the effects of workplace incivility. METHOD: A clinical scenario and script were used by actors to deliver either an uncivil or a hurried but not uncivil handoff report to participants before they conducted a focused patient assessment and administered medications to a standardized patient. RESULTS: Participants identified gaps in understanding of both handoff reports that resulted in compromised patient care. Quantitative trends showed lower resilience scores and higher stress appraisal scores for participants who received the uncivil handoff report. CONCLUSION: Although participants expressed confidence using cognitive rehearsal as an intervention before the simulation, responses indicated that a 60-minute session was insufficient to adequately prepare them to effectively address an uncivil nurse encounter. [J Contin Educ Nurs. 2023;54(2):79-88.].

Virtual simulation studies in nursing education: A bibliometric analysis of the top 100 cited studies, 2021.

OBJECTIVES: Bibliometrics is an emerging science in nursing. Quantitative methods were used to conduct a bibliometric analysis of highly cited virtual simulation nursing education articles to describe rank order, breadth of topics and authorship patterns. DESIGN AND DATA SOURCES: A desktop analysis of publication performance was conducted using the Scopus database as the source of article citation data. RESULTS AND DISCUSSION: The top 100 cited articles clustered over 14-years, 2008 to 2021. Citations per paper ranged from 88 to a low of 3 (median 18, mean 22.1) and in the top 10 studies, from 88 to 41. The citation trajectory was moderately correlated with article maturity (r = -.384, p ≤0.001). Article citations in subsequent publications commenced the first year after publication and three-year-old papers reached the mean citation rate of 22. Nurse Education Today was the most cited journal. There was no significant impact of article type (72% primary research, 17% literature reviews, 11% descriptive papers) (p = 0.755). International representation was strong, as first authors in 21 countries were cited - many (43%) from USA. One highly cited author (M. Verkuyl) from Canada led six papers, with six other authors each leading two studies. Virtual simulation modalities included virtual simulation, virtual reality simulation, 3D virtual reality simulation, virtual games and virtual worlds. The top 10 articles offer a diverse resource for faculty and educators who wish to consider using virtual simulation. CONCLUSION: Virtual simulation studies in nursing education cover an emerging field of research that has relatively low citation rates. Nursing researchers and faculty need to understand the usefulness and limitations of bibliometric analysis as this methodology can make a unique contribution to research, policy, and funding decisions, and enable productivity assessments of faculty staff and departments.

Sidelined during COVID-19: a narrative inquiry into how simulationists experienced the pandemic.

BACKGROUND: In the simulation community, colleagues who are no longer clinically practicing were often proximal to the COVID-19 response, not working in the frontlines of patient care. At the same time, their work as simulationists changed dramatically or was halted. This research explored the experiences of those simulationists who have clinical backgrounds but did not provide direct patient care during the initial pandemic response. The aim of this study was to allow those simulationists to share and have their stories heard. METHODS: This qualitative research used a narrative approach to answer the research question: What were the experiences of those in the simulation community who did not contribute to the frontline patient care response during the early stages of the pandemic? A semi-structured questionnaire aimed at eliciting a story was disseminated through online simulation discussion boards. Data was collected through PHONIC with options to type or speak responses. Responses were analyzed using an inductive analytical process to identify themes or patterns in the narratives. RESULTS: Thirty-six respondents completed the survey between August 1, 2020 and November 30, 2020. Narrative arcs were identified that illustrated the events, actions, thoughts and feelings representative of experiences shared by many simulationists. Two major themes emerged: Challenges and Opportunities. Challenges included feelings of guilt; frustration; overwhelmed, stressed and exhausted; being away from the action, being unused and underappreciated. Opportunities included leadership (evolution and innovation), personal development, and being a part of something. CONCLUSIONS: The findings reflect a snapshot in time of how simulation was viewed and used in the world during a pandemic through the personal stories of simulationists with clinical backgrounds who did not provide direct patient care. Sharing these narratives may inform future simulation development; however, it is vitally important that the emotions are recognized and acknowledged. Managers should ensure mental health resources and support are available to all staff, including those not deployed to the frontline.

Learning Outcomes Attributed to Prelicensure Clinical Education in Nursing: A Systematic Review of Qualitative Research.

BACKGROUND: Educators agree that clinical experiences are vital to the development of a graduate nurse; however, there is little research on student learning outcomes related to these experiences. PURPOSE: The purpose of this systematic review was to examine qualitative studies of student learning in traditional clinical models. METHODS: A systematic review was conducted following the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Nine electronic databases were searched using 43 search terms. Full-text review was completed on 109 articles, with 26 undergoing critical appraisal. RESULTS: Only 6 qualitative studies reported learning outcomes attributed to clinical education models, focusing on experiences in foreign clinical placements, nurse-run clinics, the night shift, transition to professional identity, practicing as a clinical dyad, and development of caring skills. CONCLUSIONS: The results of the systematic review of qualitative research that studied outcomes of prelicensure clinical education were insufficient to provide recommendations for traditional clinical education that are supported by evidence.

Personalized Training Schedules for Retention and Sustainment of Cardiopulmonary Resuscitation Skills.

INTRODUCTION: The study examined how the spacing of training during initial acquisition of cardiopulmonary resuscitation (CPR) skill affects longer-term retention and sustainment of these skills. METHODS: This was a multiphased, longitudinal study. Nursing students were randomly assigned to 2 initial acquisition conditions in which they completed 4 consecutive CPR training sessions spaced by shorter (1 or 7 days) or longer (30 or 90 days) training intervals. Students were additionally randomized to refresh skills for 1 year every 3 months, 6 months, or at a personalized interval prescribed by the Predictive Performance Optimizer (PPO), a cognitive tool that predicts learning and decay over time. RESULTS: At the end of the acquisition period, performance was better if training intervals were shorter. At 3 or 6 months after acquisition, performance was better if initial training intervals were longer. At 1 year after acquisition, compression and ventilation scores did not differ by initial training interval nor by 3-month or PPO-prescribed sustainment interval refreshers. However, 6-month interval refreshers were worse than the PPO for compressions and worse than 3 months for ventilations. At the final test session, participants in the personalized PPO condition had less variability in compression scores than either the 3- or 6-month groups. CONCLUSIONS: Results suggest that CPR learning trajectories may be accelerated by first spacing training sessions by days and then expanding to longer intervals. Personalized scheduling may improve performance, minimize performance variability, and reduce overall training time.

The Role of Technology in Health Professions Education During the COVID-19 Pandemic.

The COVID-19 pandemic has sparked radical shifts in the ways that both health care and health professions education are delivered. Before the pandemic, some degree programs were offered fully online or in a hybrid format, but in-person learning was considered essential to the education and training of health professionals. Similarly, even as the use of telehealth was slowly expanding, most health care visits were conducted in-person. The need to maintain a safe physical distance during the pandemic rapidly increased the online provision of health care and health professions education, accelerating technology adoption in both academic and professional health care settings. Many health care professionals, educators, and patients have had to adapt to new communication modalities, often with little or no preparation. Before the pandemic, the need for cost-effective, robust methodologies to enable teaching across distances electronically was recognized. During the pandemic, online learning and simulation became essential and were often the only means available for continuity of education and clinical training. This paper reviews the transition to online health professions education and delivery during the COVID-19 pandemic and provides recommendations for moving forward.

Meeting Undergraduate Nursing Students' Clinical Needs: A Comparison of Traditional Clinical, Face-to-Face Simulation, and Screen-Based Simulation Learning Environments.

BACKGROUND: Nurse educators expanded replacement of traditional clinical practice and face-to-face simulation experiences with screen-based simulation (SBS) during the COVID-19 (coronavirus disease 2019) pandemic. PURPOSE: The purpose of this research was to understand the student experience when learning in 3 types of clinical education environments. METHODS: This quantitative descriptive survey study used the Clinical Learning Environment Comparison Survey 2.0 (CLECS 2.0) to compare prelicensure nursing students' perceptions of learning in 3 clinical learning environments. RESULTS: The CLECS 2.0 was completed by 113 participants from 3 countries. Most scores were highest for the traditional clinical practice environment, and all were lowest for the SBS environment. CONCLUSIONS: The findings are concerning as discussions about whether SBS can replace traditional clinical practice hours unfolds. The findings support the need for concentrated efforts to improve specific areas of the SBS experience.

Corporate leadership training: Value added for your simulation center.

Academic leaders in nursing have invested vast resources such as dedicated space, technology, and facilitator education to support their simulation centers. In order to maximize return on investment, one school of nursing and health sciences conducted external leadership training for corporate business mid-level managers utilizing the expertise of their certified simulation educators and their accredited simulation center. The simulation team developed nine scenarios that focused on common corporate workplace challenges. Actors who would normally portray the role of simulated 'patients' were reimagined as standardized 'corporate executives and employees,' and several communication tools from the TeamSTEPPS® curriculum were adapted for use in the corporate setting. These tools were explained in a brief didactic and discussion format prior to use in simulations. Learners participated in simulation scenarios and debriefing exercises using several evidence-based methods. Details related to scenario development, standardized patient training, training experience design, large group simulations, cost development and recommendations for success are provided. Executive evaluations of the experience were so positive that the leadership training has been expanded to other external organizations.

Baseline Cardiopulmonary Resuscitation Skill Performance of Nursing Students Is Improved After One Resuscitation Quality Improvement Skill Refresher.

This article reports the results of baseline cardiopulmonary resuscitation (CPR) skills performance measurements from 467 nursing students. All participants had completed a CPR course. Baseline measurements were compared to performance after one 10-minute refresher training session on the Resuscitation Quality Improvement system. Significant improvements were made after the computer- and practice-based refresher. Findings suggest that staff developers should evaluate the use of audio and visual feedback devices to improve the quality of CPR provided by clinical staff.

Training interval in cardiopulmonary resuscitation.

AIM: Although evidence supports brief, frequent CPR training, optimal training intervals have not been established. The purpose of this study was to compare nursing students' CPR skills (compressions and ventilations) with 4 different spaced training intervals: daily, weekly, monthly, and quarterly, each for 4 times in a row. METHODS: Participants were nursing students (n = 475) in the first year of their prelicensure program in 10 schools of nursing across the United States. They were randomly assigned into the 4 training intervals in each of the schools. Students were trained in CPR on a Laerdal Resusci Anne adult manikin on the Resuscitation Quality Improvement (RQI) mobile simulation station. The outcome measures were quality of compressions and ventilations as measured by the RQI program. RESULTS: Although students were all certified in Basic Life Support prior to the study, they were not able to adequately perform compressions and ventilations at pretest. Overall compression scores improved from sessions 1 to 4 in all training intervals (all p < .001), but shorter intervals (daily training) resulted in larger increases in compression scores by session 4. There were similar findings for ventilation skills, but at session 4, both daily and weekly intervals led to better skill performance. CONCLUSION: For students and other novices learning to perform CPR, the opportunity to train on consecutive days or weeks may be beneficial: if learners are aware of specific errors in performance, it may be easier for them to correct performance and refine skills when there is less time in between practice sessions.

Planning and managing a complex multisite study in the age of technology.

A 2-year long, multisite research study that evaluated cardiopulmonary resuscitation skill decay among nursing students was conducted at 10 schools of nursing across the United States. The study was conducted in two phases and required carefully timed sessions for skill performance. Multisite studies in nursing education need to be carefully planned. Time delays should be anticipated with processes and Institutional Review Board protocols across sites. All team members were trained and consistently supported during the entire study. While challenges and obstacles were identified, innovative solutions were implemented that assisted the research team to successfully complete the study. The use of new and existing technology allowed the team to surmount many of the challenges encountered in this study. The purpose of this article is to describe the logistics, processes, challenges, and lessons learned related to conducting a complex multisite study.

Incivility behaviours exhibited by nursing students: clinical educators' perspectives of challenging teaching and assessment events in clinical practice.

Background: The increase in the frequency and severity of student incivility and unprofessional behaviours in clinical education is of concern. Aim: To determine the types and frequency of incivility and unprofessional student behaviours, triggers for disruptive behaviour and situations that clinical educators find challenging.An exploratory study using online surveys and interviews investigated perspectives of 71 respondents from two Schools of Nursing within Australia and one in the United States.Results: Almost all participants had experienced student incivility and unprofessional behaviours in the previous 12 months. A significant antecedent for these behaviours was students receiving feedback perceived to be negative. Clinical educators with experience and qualifications in education reported more incidents and frequency of student incivility and unprofessional behaviour.Conclusions: Incivility and unprofessionalism is commonly reported. It is recommended that students and faculty act proactively to prevent these behaviours, and that focused training and support to prevent, reduce and manage incivility and unprofessionalism is implemented.

Emerging Theories Influencing the Teaching of Clinical Nursing Skills.

BACKGROUND: Recognition is increasing that many psychomotor skills essential for safe nursing practice are not being retained. New theories and methods are emerging that, when applied in an organized pedagogical model, could influence initial learning and the retention of critical psychomotor skills. METHOD: This article explains and applies emerging educational theories and concepts relevant to skills teaching in nursing. RESULTS: Theories and concepts on cognitive load, deliberate practice, mastery learning, overlearning, spaced learning, and skill decay are integrated to provide a framework for teaching skills in nursing. An example is included of using this framework for skills instruction and practice. CONCLUSION: This framework may improve the nurse educator's ability to prepare learners to perform skills safely in both the skills laboratory and patient care settings and to retain skills. [J Contin Educ Nurs. 2019;50(6):257-262.].

Evaluating the Usability of a Second-Generation Virtual Reality Game for Refreshing Sterile Urinary Catheterization Skills.

BACKGROUND: Virtual reality (VR) allows risk- and anxiety-free practice, mediated by consistent objective feedback. PURPOSE: This study evaluated the usability of a VR game system for sterile catheterization practice. Participant enjoyment, engagement, likelihood to practice, and comfort using VR are reported. METHODS: Thirty-one students and faculty tested a VR game using Oculus Rift devised to allow practice of placing a urinary catheter in a virtual patient. Data were collected via an electronic survey using the System Usability Survey (SUS) and a User Reaction Survey (URS). RESULTS: The SUS score was 64.03. Seventy-five percent of participants rated the game as positive overall on the URS. Left-handed players had more difficulty playing the game. Players with prescription glasses could not comfortably place the Oculus Rift over their glasses to play. CONCLUSIONS: The VR game shows promise for refreshing sterile catheterization skills.